Nausea and Vomiting in 2021

Abstract

Goal: A comprehensive review of treatments for nausea and vomiting (N/V). Background: N/V are common symptoms encountered in medicine. While most cases of acute N/V related to a specific cause can be straightforward to manage, other cases of acute N/V such as chemotherapy-induced N/V and especially chronic unexplained N/V can be difficult to control, leading to a significant decline in the patient’s quality of life and increased cost of medical care from repeated hospitalizations. Study: Traditional management has relied on pharmacotherapy which may be inadequate in a certain proportion of these patients. Many of the medications used in the management of N/V have significant side effect profiles making the need for new and improved interventions of great importance. Results: This review covers a broad review of the pathophysiology of N/V, pharmacotherapy, including safety concerns and controversies with established pharmaceuticals, newer immunotherapies, bioelectrical neuromodulation (including gastric electrical stimulation), behavioral and surgical therapies, and complementary medicine. Conclusion: On the basis of emerging understandings of the pathophysiology of N/V, improved therapies are becoming available.

Review article: An analysis of the pharmacological rationale for selecting drugs to inhibit vomiting or increase gastric emptying during treatment of gastroparesis

“…Deudomperidone (CIN‐102 or deuterated domperidone, again similar to domperidone but with improved pharmacokinetics, efficacy and tolerability), is undergoing Phase II trials in patients with gastroparesis (https://cindome.com/cin-102). 44 The phenothiazine NG101 (a proprietary salt form of metopimozide), a D 2 receptor antagonist also binding to D 3 , α 1 ‐adrenoceptors and with lower affinity to H 1 receptors, and unable to cross the blood–brain barrier or inhibit h ERG at therapeutically‐relevant concentrations (Table 1), is undergoing Phase II trials (https://neurogastrx.com/pipeline/#section-ng101). 44 The idea that therapeutic efficacy might be achieved by combining D 2 receptor antagonism with 5‐HT 4 receptor activation (as for metoclopramide and clebopride but without brain penetration) is discussed later (Section 5).…”

Gastroparesis and Gastroparesis Syndromes as Neuromuscular Disorders

“…The next step would be symptomatic treatment and promotility drugs, realizing that there are limited numbers of these compounds that are easily available. 75 The most useful current drugs are dopamine blockers and NK-1 antagonists, although many other compounds are being studied. 76 For patients with drug-refractory gastroparesis, consideration of pyloric therapies, gastric bioelectric devices, and enteric tubes are options.…”

Electroencephalographic Changes in Pregnant Women with Hyperemesis Gravidarum: A Case–Control Study

“…Rather than being a distinct anatomical area, this is considered more of a functional zone in the medulla. This center receives inputs from the vagal afferents from the gastrointestinal tract, psychogenic stimuli from the cerebral cortex, and stimuli from the vestibular and visual areas and chemoreceptor trigger zone [8].…”